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-EASUREMENTANDSTANDARDIZATIONPROTOCOLSFOR


ANTHROPOMETRYUSEDINTHECONSTRUCTIONOFANEW
INTERNATIONALGROWTHREFERENCE

-ERCEDESDE/NIS !DELHEID7/NYANGO *AN6ANDEN"ROECK 7M#AMERON#HUMLEA


AND2EYNALDO-ARTORELL FORTHE7(/-ULTICENTRE'ROWTH2EFERENCE3TUDY'ROUP
!BSTRACT

+EYWORDS!NTHROPOMETRY GROWTHCURVES GROWTH


REFERENCES HEIGHT LENGTH METHODS SKINFOLD WEIGHT

4HOROUGHTRAINING CONTINUOUSSTANDARDIZATION ANDCLOSE


MONITORINGOFTHEADHERENCETOMEASUREMENTPROCEDURES
DURING DATA COLLECTION ARE ESSENTIAL FOR MINIMIZING
RANDOMERRORANDBIASINMULTICENTERSTUDIES2IGOROUS
ANTHROPOMETRYANDDATACOLLECTIONPROTOCOLSWEREUSEDIN
THE7(/-ULTICENTRE'ROWTH2EFERENCE3TUDYTOENSURE
HIGHDATAQUALITY!FTERTHEINITIALTRAININGANDSTAND
ARDIZATION STUDYTEAMSPARTICIPATEDINSTANDARDIZATION
SESSIONSEVERYTWOMONTHSFORACONTINUOUSASSESSMENTOF
THEPRECISIONANDACCURACYOFTHEIRMEASUREMENTS/NCEA
YEARTHETEAMSWERERESTANDARDIZEDAGAINSTTHE7(/LEAD
ANTHROPOMETRIST WHOOBSERVEDTHEIRMEASUREMENTTECH
NIQUESANDRETRAINEDANYDEVIATINGOBSERVERS2OBUSTAND
PRECISEEQUIPMENTWASSELECTEDANDADAPTEDFORFIELDUSE
4HEANTHROPOMETRISTSWORKEDINPAIRS TAKINGMEASURE
MENTSINDEPENDENTLY ANDREPEATINGMEASUREMENTSTHAT
EXCEEDEDPRESETMAXIMUMALLOWABLEDIFFERENCES/NGOING
CENTRALANDLOCALMONITORINGIDENTIFIEDANTHROPOMETRISTS
DEVIATINGFROMSTANDARDPROCEDURES ANDIMMEDIATECOR
RECTIVEACTIONWASTAKEN4HEPROCEDURESDESCRIBEDINTHIS
PAPERAREAMODELFORRESEARCHSETTINGS

-ERCEDESDE/NISAND!DELHEID7/NYANGOAREAFFILIATED
WITHTHE$EPARTMENTOF.UTRITION 7ORLD(EALTH/RGANIZA
TION 'ENEVA*AN6ANDEN"ROECKISAFFILIATEDWITHTHE!FRICA
#ENTRE FOR (EALTH AND 0OPULATION 3TUDIES -TUBATUBA
3OUTH!FRICA7M#AMERON#HUMLEAISAFFILIATEDWITHTHE
$EPARTMENTOF#OMMUNITY(EALTH ,IFESPAN(EALTH2ESEARCH
#ENTER 7RIGHT3TATE5NIVERSITY3CHOOLOF-EDICINE +ETTERING
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%MORY5NIVERSITY !TLANTA 'EORGIA 53!
0LEASE DIRECT QUERIES TO -ERCEDES DE /NIS 3TUDY #OOR
DINATOR $EPARTMENT OF .UTRITION 7ORLD (EALTH /RGANI
ZATION  !VENUE !PPIA  'ENEVA  3WITZERLAND
4ELEPHONE     FAX     E MAIL
DEONISM WHOINT
-EMBERS OF THE 7(/ -ULTICENTRE 'ROWTH 2EFERENCE
3TUDY'ROUPAND!CKNOWLEDGMENTSARELISTEDATTHEENDOF
THEFIRSTPAPERINTHISSUPPLEMENTPP3n3 
-ENTIONOFTHENAMESOFFIRMSANDCOMMERCIALPRODUCTS
DOESNOTIMPLYENDORSEMENTBYTHE5NITED.ATIONS5NIVERSITY

)NTRODUCTION
4HE7ORLD(EALTH/RGANIZATION7(/ -ULTICENTRE
'ROWTH2EFERENCE3TUDY-'23 WASUNDERTAKENTO
GENERATENEWGROWTHCURVESFORASSESSINGTHEGROWTH
ANDDEVELOPMENTOFINFANTSANDYOUNGCHILDRENFROM
AROUNDTHEWORLD4HECHILDRENINCLUDEDINTHESTUDY
CAMEFROMSIXCOUNTRIES"RAZIL 'HANA )NDIA .ORWAY
/MAN ANDTHE5NITED3TATES4HEMETHODOLOGYAND
ELIGIBILITY CRITERIA FOR THE STUDY HAVE BEEN DESCRIBED
ELSEWHERE IN THIS SUPPLEMENT ;= )DENTICAL RIGOROUS
DATA COLLECTION PROCEDURES WERE FOLLOWED IN ALL SITES
INORDERTOMINIMIZEMEASUREMENTERRORANDTOAVOID
SYSTEMATICDIFFERENCESAMONGSITES
6ARIABILITY IN INFANT AND CHILD MEASUREMENTS CAN
RESULT FROM A NUMBER OF INFLUENCES THE SETTING IN
WHICHTHEMEASUREMENTSARETAKENSTOMACHANDBLAD
DERVOLUMEINTHECASEOFWEIGHT DIURNALVARIATION
IN LENGTHHEIGHT  THE BEHAVIOR AND COOPERATION OF
THECHILDBEINGMEASUREDTHEACCURACYANDPRECISION
OF THE INSTRUMENTS THE ANTHROPOMETRISTS TECHNICAL
CAPACITYTRAINING EXPERIENCE ANDRELIABILITY FITNESS
ANDMOODANDTHEMETHODSOFDATARECORDINGREAD
ING WRITINGDOWN !PPROPRIATETRAININGANDCONTIN
UEDSTANDARDIZATION ADHERENCETOSPECIFIEDMETHODS
AND PROCEDURES AND MONITORING OF DATA QUALITY ARE
ESSENTIALTOREDUCEMEASUREMENTERRORANDMINIMIZE
BIAS IN MULTISITE STUDIES 4HE PURPOSE OF THIS ARTICLE
ISTODESCRIBETHEMEASUREMENTPROTOCOLSANDROUTINE
STANDARDIZATIONSESSIONSTHATWEREUSEDINTHE-'23
4HESTUDYPROTOCOLSANDQUALITYCONTROLPROCEDURESCAN
BE APPLIED IN RESEARCH SETTINGS WITHOUT SUBSTANTIALLY
INCREASINGCOSTSORCOMPLICATINGLOGISTICS

3ELECTIONANDTRAININGOFANTHROPOMETRISTS
4HE FIELD STAFF COLLECTING ANTHROPOMETRIC DATA IN THE

&OODAND.UTRITION"ULLETIN VOL NOSUPPLEMENT  4HE5NITED.ATIONS5NIVERSITY

3

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JECTSINTHETESTnRETESTSTUDY4HEMOSTCOMMONLYUSED
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MEASUREMENT4%- ;=
&OLLOWING THE INITIAL STANDARDIZATION SESSION AND
THROUGHOUT THE DATA COLLECTION PHASE EACH SITE CON
DUCTEDSTANDARDIZATIONSESSIONSBIMONTHLYEVERYTWO
MONTHS THATCOINCIDEDONCEAYEARWITHTHEVISITOF
THE7(/LEADANTHROPOMETRIST4HEPURPOSEOFTHESE
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3

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